Project Summary: American Indians and Alaska Natives (AI/AN) suffer from disproportionate mortality from colorectal cancer and have among the lowest screening rates for any ethnic group (current FOBT = 14%, current endoscopy = 25%), while incidence is rising. Despite their high mortality (49% of AI/AN men with colorectal cancer will die from it; 37% of AI/AN women), no study has yet been conducted to determine the reasons behind their lag in screening behavior, Likewise, no interventions to increase screening have been attempted. Therefore, we propose a systematic, ethnographic assessment of needs and barriers to colorectal cancer screening, as well as knowledge and beliefs about the disease, in a heterogeneous AI/AN group, including many different tribes and urban, rural, and reservation populations. Once we understand needs, barriers, knowledge, and beliefs, we can begin to develop screening programs specific to this population. We plan to work with the Haskell Health Center, the American Indian Heartland Cancer Network, and the American Indian Council of Kansas City to reach both urban and rural communities in Kansas and the Kansas City Metro Area. We will address the following specific aims: (1) To identify what medical staff believe are the greatest needs and barriers to colorectal cancer screening for AI/AN; (2) To identify what AI/AN community members believe are the greatest needs and barriers to colorectal cancer screening; and (3) To understand knowledge and attitudes of AI/AN with regards to colorectal cancer and its screening. Using a Critical Medical Anthropology framework, we will use ethnographic interviews with health center personnel and key informants and focus groups with community members. Our qualitative research will be augmented with quantitative ethnographic techniques, including free lists, pile sorts, and ranking exercises. Relevance: One of the greatest objectives of public health is to decrease health disparities in underserved populations, including ethnic minorities. AI/AN suffer from greater health disparities than any other ethnic minority, including lower rates of cancer screening and disproportionate mortality from all major cancers. We propose a project that will examine needs, barriers, knowledge and attitudes surrounding colorectal cancer and its screening in this population, which can ultimately be used to develop a cancer screening program that addresses the unique needs of this population. [unreadable] [unreadable] [unreadable]